Cost burden following esophagectomy: A single centre observational study

Abstract

BACKGROUND Cost analyses of patients undergoing esophagectomy is valuable for identifying modifiable expenditure drivers to target and curtail costs while improving the quality of care. We aimed to define the cost-complication relationship after esophagectomy and delineate the incremental contributions to costs. AIM To assess the relationship between the hospital costs and potential cost drivers post esophagectomy and investigate the relationship between the cost-driving variables (predicting variables) and hospital costs (dependent variable). METHODS In this retrospective single center study, the severity of complications was graded using the Clavien-Dindo (CD) classification system. Key esophagectomy complications were categorized and defined according to consensus guidelines. Raw costing data included the in-hospital costs of the index admission and any unplanned admission within 30 postoperative days. We used correlation analysis to assess the relationship between key clinical variables and hospital costs (in United States dollars) to identify cost drivers. A mediation model was used to investigate the relationship between these variables and hospital costs. RESULTS A total of 110 patients underwent primary esophageal resection. The median admission cost was $47822.7 (interquartile range: 35670.2-68214.0). The total effects on costs were $13593.9 (95%CI: 10187.1-17000.8, P < 0.001) for each increase in CD severity grade, $4781 (95%CI: 3772.7-5789.3, P < 0.001) for each increase in the number of complications, and $42552.2 (95%CI: 8309-76795.4, P = 0.015) if a key esophagectomy complication developed. Key esophagectomy complications drove the costs directly by $11415.7 (95%CI: 992.5-21838.9, P = 0.032). CONCLUSION The severity and number of complications, and the development of key esophagectomy complications significantly contributed to total hospital costs. Continuous institutional initiatives and strategies are needed to enhance patient outcomes and minimize costs.

Open Versus Hybrid and Total Minimally Invasive Transthoracic Ivor Lewis Esophagectomy Following Neoadjuvant FLOT Chemotherapy: An Australian and New Zealand Cohort Study

“…Consistent with the above findings, there was a stepwise decrease in postoperative length of stay between hybrid MIO versus open esophagectomy [Median (IQR) days, 13 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) versus 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), p = 0.240], and total MIO versus open esophagectomy [Median (IQR) days, 10 (8-12) versus 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), p = 0.045] (Table 3). Total MIO was also associated with a lower 30-day hospital readmission rate when compared with hybrid MIO (OR 0.25, 95% CI 0.05-1.00, p = 0.030, Supporting Information S1: Table S3) and open esophagectomy (OR 0.29, 95% CI 0.07-1.18, p = 0.084, Table 3).…”

“…From a health economic perspective, our findings of reduced major complications (total MIO 15.6% vs. open 38.7%) and shorter length of stay (median 10 vs. 14 days) have important cost implications. Recent Australian data demonstrate that each increase in Clavien‐Dindo severity grade adds approximately USD $13,594 to hospital costs, with major complications doubling admission costs [ 23 ]. This further underscores the potential clinical and economic benefit of minimally invasive techniques in esophagectomy.…”

Open Versus Hybrid and Total Minimally Invasive Transthoracic Ivor Lewis Esophagectomy Following Neoadjuvant FLOT Chemotherapy: An Australian and New Zealand Cohort Study

“…Consistent with the above findings, there was a stepwise decrease in postoperative length of stay between hybrid MIO versus open esophagectomy [Median (IQR) days, 13 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) versus 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), p = 0.240], and total MIO versus open esophagectomy [Median (IQR) days, 10 (8-12) versus 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), p = 0.045] (Table 3). Total MIO was also associated with a lower 30-day hospital readmission rate when compared with hybrid MIO (OR 0.25, 95% CI 0.05-1.00, p = 0.030, Supporting Information S1: Table S3) and open esophagectomy (OR 0.29, 95% CI 0.07-1.18, p = 0.084, Table 3).…”

“…From a health economic perspective, our findings of reduced major complications (total MIO 15.6% vs. open 38.7%) and shorter length of stay (median 10 vs. 14 days) have important cost implications. Recent Australian data demonstrate that each increase in Clavien‐Dindo severity grade adds approximately USD $13,594 to hospital costs, with major complications doubling admission costs [ 23 ]. This further underscores the potential clinical and economic benefit of minimally invasive techniques in esophagectomy.…”

Open Versus Hybrid and Total Minimally Invasive Transthoracic Ivor Lewis Esophagectomy Following Neoadjuvant FLOT Chemotherapy: An Australian and New Zealand Cohort Study

“…Consistent with the above findings, there was a stepwise decrease in postoperative length of stay between hybrid MIO versus open esophagectomy [Median (IQR) days, 13 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) versus 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), p = 0.240], and total MIO versus open esophagectomy [Median (IQR) days, 10 (8-12) versus 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), p = 0.045] (Table 3). Total MIO was also associated with a lower 30-day hospital readmission rate when compared with hybrid MIO (OR 0.25, 95% CI 0.05-1.00, p = 0.030, Supporting Information S1: Table S3) and open esophagectomy (OR 0.29, 95% CI 0.07-1.18, p = 0.084, Table 3).…”

“…From a health economic perspective, our findings of reduced major complications (total MIO 15.6% vs. open 38.7%) and shorter length of stay (median 10 vs. 14 days) have important cost implications. Recent Australian data demonstrate that each increase in Clavien‐Dindo severity grade adds approximately USD $13,594 to hospital costs, with major complications doubling admission costs [ 23 ]. This further underscores the potential clinical and economic benefit of minimally invasive techniques in esophagectomy.…”

Open Versus Hybrid and Total Minimally Invasive Transthoracic Ivor Lewis Esophagectomy Following Neoadjuvant FLOT Chemotherapy: An Australian and New Zealand Cohort Study

“…Consistent with the above findings, there was a stepwise decrease in postoperative length of stay between hybrid MIO versus open esophagectomy [Median (IQR) days, 13 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) versus 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), p = 0.240], and total MIO versus open esophagectomy [Median (IQR) days, 10 (8-12) versus 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), p = 0.045] (Table 3). Total MIO was also associated with a lower 30-day hospital readmission rate when compared with hybrid MIO (OR 0.25, 95% CI 0.05-1.00, p = 0.030, Supporting Information S1: Table S3) and open esophagectomy (OR 0.29, 95% CI 0.07-1.18, p = 0.084, Table 3).…”

“…From a health economic perspective, our findings of reduced major complications (total MIO 15.6% vs. open 38.7%) and shorter length of stay (median 10 vs. 14 days) have important cost implications. Recent Australian data demonstrate that each increase in Clavien‐Dindo severity grade adds approximately USD $13,594 to hospital costs, with major complications doubling admission costs [ 23 ]. This further underscores the potential clinical and economic benefit of minimally invasive techniques in esophagectomy.…”